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Pembrolizumab monotherapy for advanced/recurrent non-small cell lung cancer: a Greater Manchester experience
Tivey, A. Wu, K S Tay, Rebecca Gomes, Fabio Taylor, Paul Blackhall, Fiona H Summers, Yvonne J Califano, Raffaele Cove-Smith, Laura
Tivey, A.
Wu, K S
Tay, Rebecca
Gomes, Fabio
Taylor, Paul
Blackhall, Fiona H
Summers, Yvonne J
Califano, Raffaele
Cove-Smith, Laura
Citations
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Abstract
Introduction: Pembrolizumab monotherapy is first-line (FL) treatment
for patients with advanced/recurrent non-small cell lung
cancer with PD-L1 ≥50% and second-line (SL) for PD-L1 ≥1%. Here
we report on a cohort of 173 patients (76FL, 97 SL) who received
pembrolizumab as standard of care across Greater Manchester.
Methods: Patients were identified using chemotherapy prescribing
software and Blue-teq Cancer Drugs Fund forms. Case-notes and
imaging were reviewed to obtain data on demographics, response,
toxicities and progression/survival. Analysis was performed using
SPSS.
Results: Median age was 69 years (70FL, 68SL, range 34-88); 98 were
male and 75 female. 156 were former or current smokers. 11 had previous treatment for brain metastases. Best response (according
to local radiological reporting/clinical progression) was assessed in
155. 45.2% progressed and 54.8% stabilised or responded. 22 patients
continued treatment beyond progression and 8 subsequently
derived benefit (stabilised or responded). Median PFS was 6 months
in FL and 3 months in SL patients. Median OS had not yet been
reached but median OS at 6 months was 69.7% in FL and 73.2% in SL.
PFS was significantly different (log-rank p=0.004) between patients
with PD-L1 ≥50% (median PFS 6.9 months) and patients with PD-L1
<50% (median PFS 2.6 months). No significant difference in overall
survival (p=0.46). 44.6% patients experienced immune related
adverse events (IRAE) (55.3% FL, 38.14% SL). 10.4% patients developed
grade 3-5 IRAEs, including one death due to pneumonitis. 16.2%
received systemic steroids and 9.2% discontinued treatment due to
toxicity. There was no significant relationship between age and the
presence of any IRAE (p=0.36).
Conclusion: Pembrolizumab is well tolerated in real world patients,
with lower rates of IRAEs than Keynote 024. PFS and OS appear
worse, but FL pembrolizumab data are immature and longer followup
is needed. Results support the use of PD-L1 expression as a
predictive biomarker of response to pembrolizumab.
Description
Date
2019
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Tivey A, Wu KS, Tay R, Gomes F, Taylor P, Blackhall F, et al. Pembrolizumab monotherapy for advanced/recurrent non-small cell lung cancer: a Greater Manchester experience. Lung Cancer. 2019;127:S45-S6.